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General NPI Number Information
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NPI Number | 1972728525
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Entity Type | Individual
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Provider Name | DIANA SOPHIA NYCHKA O.D.
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Gender | Female
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 93 BOSTON POST RD
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City | ORANGE
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State | CT
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Zip | 06477-3203
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Country | US
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Telephone | 203-799-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 10 OLD FIELD PL
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City | NORWALK
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State | CT
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Zip | 06853-1116
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Country | US
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Telephone | 203-956-7496
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2635
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License Number State | CT
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